Intraoperative Fluoroscopy Time Research Articles

Clinical outcomes of guider-assisted osteotomy compared to conventional pendulum-saw osteotomy in open wedge high tibial osteotomy: a propensity score-matched cohort study

PurposeWe developed a novel guider-assisted osteotomy (GAO) procedure to improve the safety of open wedge high tibial osteotomy (OWHTO) and aimed to compare its efficacy and complications with the conventional pendulum-saw osteotomy (PSO).MethodsThis is a retrospective cohort study of patients undergoing either GAO or PSO procedure in the OWHTO to treat varus knee osteoarthritis, who had a minimum of 2 years of follow-up. Patients were propensity score matched (PSM) in a 1:1 ratio based on demographic and clinical data with a caliper width of 0.02. The outcomes assessed involved the hospital for special surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and the Intraoperative and postoperative complications.Results199 patients were included in each group after PSM. The mean duration of follow-up was 38.3 ± 8.9 months. The GAO group had a shorter operation duration (104.5 ± 35.7 vs. 112.1 ± 36.0 min, p = 0.027) and fewer times of intraoperative fluoroscopy (4.2 ± 1.4 vs. 6.0 ± 1.4, p < 0.001). At the last follow-up, clinical scores for knee achieved significant improvements in both GAO and PSO groups: HSS (67.5 ± 10.5 vs. 90.2 ± 7.0, p < 0.001; 69.4 ± 8.2 vs. 91.7 ± 6.8, p < 0.001) and WOMAC (65.7 ± 11.6 vs. 25.2 ± 10.4, p < 0.001; 63.3 ± 12.2 vs. 23.8 ± 9.5, p < 0.001). However, no significant difference was observed between groups for any measures (p > 0.05). In addition, the intraoperative complications (0.5% vs. 3.5%, p = 0.068) and the postoperative bone delayed union and nonunion (1.0% vs. 4.5%, p = 0.032) were marginally or significantly reduced in the GAO versus PSO group.ConclusionGAO demonstrates improvements in intraoperative radiation exposure and complications, with comparable short-term efficacy to PSO, and could be considered a viable alternative in clinical practice.

Impact of previously failed extracorporeal shock wave lithotripsy on ureterorenoscopy outcomes in upper urinary tract stones: a prospective comparative study.

We sought to prospectively evaluate the impact of previously failed SWL on subsequent URS outcomes in the treatment of upper urinary tract stones. Between May 2021 and May 2023, one hundred thirty-six patients with proximal ureteral stones < 1.5cm and renal stones < 2.5cm who were candidates for URS were prospectively assigned to a non-SWL group, which included patients without a history of failed SWL before URS, and a post-SWL group, which included patients with a history of failed SWL before URS. The success rate was the primary outcome. The perioperative data of the two groups were compared. The stone-free rate was 83.3% in the post-SWL group versus 81.3% in the non-SWL group, and 8.3% in the post-SWL group versus 9.4% in the non-SWL group had clinically insignificant residual fragments. There was no significant difference in the stone-free rate or success rate between the groups. No significant differences in intraoperative fluoroscopy time, operative time, intraoperative stone appearance, perioperative complications, or the presence of embedded fragments in the ureteral mucosa were detected between the two groups. Compared with patients who underwent primary URS, patients who underwent salvage URS for upper urinary tract stones had similar stone-free rates, success rates, operative times, fluoroscopy times, and complication rates without any significant differences.

Robot-assisted versus traditional surgery in the treatment of intertrochanteric fractures: a meta-analysis

Intramedullary nail fixation of intertrochanteric fractures assisted by orthopedic surgical robot navigation is a new surgical method, but there are few studies comparing its efficacy with traditional intramedullary nail fixation. We aimed to assess whether robot-assisted internal fixation confers certain surgical advantages through a literature review. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wan fang Data Knowledge service Platform were searched to collect randomized and non-randomized studies on patients with calcaneal fractures. Five studies were identified to compare the clinical indexes. For the clinical indexes, the technology of robot-assisted is generally feasible, in time to operation, intraoperative fluoroscopy times, blood loss, pine insertion, tip apex distance (TAD), and Harris score (P < 0.05). However, on the complication and excellent and good rate after operation did not show good efficacy compared with the traditional group (P > 0.05). Based on the current evidence, For the short-term clinical index, the advantages of robot-assisted are clear. The long-term clinical effects of the two methods are also good, but the robot-assisted shows better. However, the quality of some studies is low, and more high-quality randomized controlled trials (RCTs) are needed for further verification.

The use of intramedullary reduction techniques in the treatment of irreducible intertrochanteric femoral fractures with negative medial cortical support.

To explore the clinical efficacy of intramedullary reduction techniques for irreducible intertrochanteric femoral fractures with negative medial cortical support. A retrospective analysis was conducted on 69 patients with irreducible intertrochanteric femoral fractures with negative medial cortical support treated in the Department of Orthopedics at Jiangsu Province Hospital (The First Affiliated Hospital of Nanjing Medical University) from July 2019 to December 2021. Patients were divided into Group A and Group B. Group A (experimental group) consisted of 36 cases with an average age of 76.2 ± 5.9 years, while Group B (control group) comprised 33 cases with an average age of 76.6 ± 6.3 years. Group A received treatment using intramedullary reduction techniques, while Group B received treatment using traditional extramedullary reduction techniques. Both groups achieved anatomic reduction of the medial cortex or slight positive support. Surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, femoral neck shortening, and hip joint functional recovery score (FRS) were compared between the two groups. All patients were followed up for an average of 13.8 months. Group A showed superior outcomes compared to Group B in surgical duration, intraoperative fracture reduction time, intraoperative bleeding, intraoperative fluoroscopy time, fracture reduction quality, fracture healing, postoperative neck-shaft angle loss, and femoral neck shortening (P < 0.05). Hip joint function assessed by functional recovery score was better in Group A than Group B at 1 and 3 months postoperatively (P < 0.05), with no significant statistical difference at other time points (P > 0.05). For irreducible intertrochanteric femoral fractures with negative medial cortical support, intramedullary reduction techniques used during surgery demonstrated simplicity, significant reduction in surgical duration, decreased intraoperative bleeding, fewer amounts of intraoperative fluoroscopy, improved fracture reduction quality, and reduced surgical complexity. Further clinical research and application are warranted.

Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis.

Blocking screw technique has been widely applied in the treatment of long shaft fractures. However, the evidence with regard to whether intramedullary nail combined with blocking screw technique has better clinical efficacy over other is not clear. The aim of the study was to explore the clinical efficacy and complications of intramedullary nail combined with blocking screw technique in the treatment of femoral or tibial shaft fractures. The PuMed, Embase, OVID, Cochrane library, Web of Science, Wanfang, CNKI and Weipu data were searched for studies of intramedullary nail combined with blocking screw in treatment of femoral or tibial shaft fracture published up to Aug 31 2023. Methodological quality of the trials was assessed, relevant data were extracted, and RevMan 5.3 and Stata 15.0 software were used to perform the meta-analysis of parameters related to the consequences. Twenty articles were included, including 1267 patients. Meta-analysis results showed that compared with the non-blocking screw group, the blocking screw group had longer operation time (WMD = 13.24; 95% CI = 5.68-20.79, P = .0006) and more intraoperative fluoroscopy times (WMD = 57.62; 95% CI = 25.82-89.42, P = .0002). However, the postoperative therapeutic response rate was higher (OR = 5.60; 95% CI = 2.10-14.93, P = .0006), postoperative ankle joint function was better (OR = 3.48; 95% CI = 1.20-10.13, P = .02), and fracture healing rate was higher (OR = 3.56; 95% CI = 1.43-8.89, P = .006), fracture healing time was shorter (WMD = -3.59; 95% CI = -4.96 to -2.22, P < .00001), intraoperative blood loss was less (WMD = -54.80; 95% CI = -88.77 to -20.83, P = .002), hospitalization time was shorter (WMD = -1.66; 95% CI = -2.08 to -1.24, P < .00001), and complications were less (OR = 0.38; 95% CI = 0.16-0.89, P = .01). There was no statistical significance in the range of motion of knee joint between the 2 groups (WMD = 10.04; 95% CI = -1.51 to 21.59, P = .09). Current evidence shows that intramedullary nail combined with blocking screw technique in the treatment of lower limb long bone fracture has the advantages of good clinical efficacy, high fracture healing rate, short fracture healing time, good joint function, less complications and so on, which is worthy of clinical recommendation.

Is There Still a Learning Curve for Primary TAA After Completing a High Volume Ankle Replacement Fellowship? A Multicentered Study

Introduction/Purpose: The learning curve in Total ankle arthroplasty(TAA) has long been reported. Surgeon experience of five to twenty-five ankle replacements have been shown to decrease various perioperative and long term complications in this complex surgery. Fellowship programs with high-volume ankle arthroplasty experiences have been suggested to mitigate this learning curve and provide benefit to early career surgeons with TAA outcomes. The purpose of this study was to evaluate the learning curve for TAA in two high-volume surgeons practices through the first three years of practice. Both surgeons completed fellowships and participated in more than 100 ankle replacements each. We hypothesized that experience during fellowship will help minimize complications and negate any learning curve previously established in the literature. Methods: Prospectively collected data was retrospectively reviewed on all patients who underwent primary TAA surgery during the first three years of clinical practice after fellowship in this IRB approved, multi-centered study. Patient demographics and clinical data, radiographic outcomes, and patient reported outcomes were collected on all patients. Patients undergoing revision TAA (as a first surgery), patients without a minimum of 2 years follow-up, and patients undergoing arthrodesis conversion to TAA were all excluded. The data was analyzed using Chi Squared test and the Moving Average Method where appropriate. All statistical analysis was performed by someone with an expertise in biostatistics. Results: Eighty-seven patients (67.8% male, avg. age 64) met inclusion criteria for the study. Average tourniquet time (111.9 min) and fluoroscopy time(106.3 secs) decreased as surgeon experience increased, with the this trend stabilizing after patient 20. Complication rate (wound complication, infection, return to OR, intraoperative fracture, etc.) was similar throughout the study period. No differences were seen in component positioning (postop AP TT angle, Postop Lateral TT angle), PROMIS Pain interference, PROMIS Depression, or PROMIS Physical function with regards to time during the study. Statistically significant differences (improvements) were seen in in the following postoperative measurements when compared to preoperative values: AP TT angle, Lateral TT angle, and PROMIS Pain Interference/Depression/Physical function. Conclusion: Learning curve as it relates to intraoperative fluoroscopy time and intraoperative tourniquet time remained even after completing a high volume TAA fellowship but clinical and PROs did not show this same trend. Radiographic measurements, complications (both intraop and postop), and patient reported outcomes did not show a time sensitive change after fellowship. Though some variables did show the maintenance of a learning curve, this multi-centered study suggests that completion of a high volume TAA fellowship can mitigate some variables in the learning curve. Study Data Summary

The Use of Spiral Cement Injector for Percutaneous Vertebroplasty to Treat Kümmell Disease: A Retrospective Study

Percutaneous vertebroplasty (PVP) is a common method used to treat Kümmell disease. In patients without neurologic symptoms, we sought to evaluate whether using the new spiral injectors instead of the traditional push-rod injectors in PVP can result in improved clinical efficacy for the treatment of Kümmell disease. A clinical retrospective study was conducted between August 2018 and December 2020. The study included patients diagnosed with single-level thoracolumbar Kümmell disease who underwent PVP surgery. The patients were divided into 2 groups: an observation group consisting of 53 patients treated with spiral injectors and a control group consisting of 68 patients treated with push-rod injectors. A 2-year follow-up period was adopted. The bone cement injection volume and occurrence of bone cement leakage were significantly greater in the observation group compared with the control group (P < 0.05). The observation group had significantly shorter operation time and intraoperative fluoroscopy times compared with the control group (P < 0.05). The scores for the visual analog scale and Oswestry Disability Index in both groups were significantly lower at 3 days or 3 months and 2 years after surgery compared with before surgery, with the scores at 2 years after surgery being significantly lower than those at 3 days or 3 months for both groups (P < 0.05). The relative anterior ledge height and Cobb angle showed significant improvement at 3 days and 2 years after surgery compared with before surgery in both groups (P < 0.05), but patients in the observation group experienced substantial improvement at 3 days and 2 years after surgery compared with those in the control group (P < 0.05). In both groups, the relative anterior ledge height was noticeably lower 2 years after surgery compared with 3 days after surgery (P < 0.05). Concurrently, there was a significant increase in the local Cobb angle over time in both groups (P < 0.05). The implementation of both spiral injectors and traditional push-rod injectors in PVP surgery yields effective pain relief, improved function, partially restored vertebral height, and corrected kyphosis in treating Kümmell disease. Compared with the push-rod injector, the spiral injector is highly efficient in restoring vertebral height, correcting kyphosis, and minimizing fluoroscopy use and operation time, but it carries a greater risk of bone cement leakage.

Clinical Application and Curative Effect Analysis of Postural Awareness Surgical Tool Assisted Nail Placement in Adolescent Idiopathic Scoliosis.

The pedicle screw technique has been widely used in adolescent idiopathic scoliosis orthopedic surgery, but misplacement of screws may damage important structures such as blood vessels and nerves around the pedicle, resulting in serious consequences. Therefore, our research team has independently developed a surgical tool to assist in the placement of pedicle screws. This study aims to investigate the safety and accuracy of postural awareness tool assisted nail placement in orthopedic surgery for adolescent idiopathic scoliosis. A retrospective analysis was performed on 24 adolescent patients with idiopathic scoliosis admitted to our hospital from July 2019 to July 2022, including 10 males and 14 females, with an average age of 14.88 ± 2.36 years (10-19 years). The mean follow-up was 15.67 ± 2.20 months (12-20 months). We divided the patients into postural awareness group (n = 12) and C-arm group (n = 12) according to whether the postural awareness surgical tool was used during the operation. All patients were treated with posterior spinal orthopedic surgery. The postural awareness group was assisted by pedicle screw placement with a postural awareness surgical tool, while the C-arm group was given a pedicle screw placement with freehand technique. The operative time, intraoperative blood loss, intraoperative fluoroscopy times, nail placement related complications, nail placement accuracy, and scoliosis correction rate were recorded and compared between the two groups. The operative time, intraoperative blood loss and fluoroscopy times in the postural awareness group were significantly lower than those in the C-arm group, with statistical significance (p < 0.05). The postural awareness group implanted 163 screws with an accuracy rate of 91.41%, while the C-arm group implanted 159 screws with an accuracy rate of 83.02%. The accuracy rate of screw placement in the postural awareness group was higher than that in the C-arm group, with a statistically significant difference (p = 0.024). According to the imaging of the patients, there was no significant difference between the Cobb Angle of the main bend measured at three time points before surgery, 1 week after surgery and the last follow-up between the two groups. Similarly, there was no significant difference in the rate of lateral curvature correction between the two groups. The application of postural awareness surgical tool in posterior orthopedic surgery for adolescent idiopathic scoliosis can improve screw placement accuracy, shorten screw placement time, and make auxiliary screw placement safer and more accurate.

Comparison of the efficacy of TiRobot orthopaedic robot assisted F screw technique and inverted triangle parallel nail internal fixation in the treatment of unstable femoral neck fractures

To compare the effectiveness of TiRobot assisted F screw technique and inverted triangle parallel nail internal fixation in the treatment of unstable femoral neck fractures. A retrospective analysis was conducted on 72 patients with unstable femoral neck fractures who were treated with percutaneous cannulated screw fixation assisted with TiRobot Orthopaedic robot from December 2019 to April 2021. Among them, 37 patients were treated with F screw internal fixation, including 16 males and 21 females, aged 47 to 64 years old with an average of （53.87±5.28） years old；According to Pauwels classification, there were 1 case of type Ⅰ, 19 cases of type Ⅱ, 17 cases of type Ⅲ；8 cases of combined medical diseases；17 cases of falling, 8 cases of traffic accident and 12 cases of falling from height；The time from injury to operation was 29 to 49 hours with average of （35.00±7.34） hours. Another 35 cases used internal fixation with an inverted triangle parallel nail, including 13 males and 22 females with an average age of 46 to 63 years old （52.36±5.05） years old；According to the Pauwels injury classification：there were 2 cases of type Ⅰ, 21 cases of type Ⅱ, 12 cases of type Ⅲ；6 cases of medical diseases, 15 cases of falling injury, 9 cases of traffic accident, 11 cases of falling injury；The time from injury to operation was 30 to 45 hours with an average of （33.00±6.83） h. The intraoperative blood loss, operation time, intraoperative fluoroscopy times, follow-up time, fracture healing time, postoperative complications were observed and compared between the two groups. The hip joint function was evaluated by Harris score at 6 months and 12 months after operation. There was no significant difference in operation time, intraoperative blood loss, intraoperative fluoroscopy times and other intraoperative data between two groups（P>0.05）. Both groups were followed up regularly, and the follow-up time was 12 to 16 months. The fracture healing time and Harris score of the F screw internal fixation group were better than those of the inverted triangle parallel nail internal fixation group （P<0.05）. There was 1 case of femoral neck shortening in the F screw internal fixation group, 1 case of nonunion, 1 case of nail withdrawal, and 1 case of lower extremity deep vein thrombosis in the inverted triangle internal fixation group. The incidence of complications in the F screw internal fixation group was lower than that in the inverted triangle parallel nail internal fixation group（P<0.05）. Percutaneous cannulated F screw technique using Tirobot navigation positioning system is a safe and effective treatment for patients with unstable femoral neck fractures. It can significantly shorten the fracture healing time, reduce the incidence of postoperative complications, significantly improve hip joint function, and improve the quality of life.

Real-time traking and virtual reality technology-assisted trauma orthopaedic surgery robot for femoral neck fractures

To investigate the effectiveness of real-time tracking and virtual reality technology（RTVI） used to assist the intraoperative alignment of the trauma orthopaedic surgery robot for the treatment of femoral neck fractures and its impact on the treatment outcome. A retrospective analysis was conducted on 60 patients with femoral neck fractures treated with trauma orthopedic robotic surgery from September 2020 to September 2022. Patients were divided into two groups according to whether RTVI technology was used during surgery to assist robotic surgery. There were 28 patients in the RTVI group （12 males and 16 females）, with an average age of （46.2±9.3） years old ranging from 28 to 60 years old. There were 32 patients in the simple Tianji surgical robot group, including 15 males and 17 females, aged （48.2±7.8） years old ranging from 32 to 58. The number of registered fluoroscopy, operation time, total number of intraoperative fluoroscopy, intraoperative blood loss, and hospitalization time of the two groups of patients were observed and recorded. All patients received regular follow-up after surgery, and hip X-rays were routinely reviewed to record Garden alignment index, fracture healing time, postoperative complications, and Harris score. All 60 patients were followed up. The RTVI group was followed up for 9 to 16 months with an average of （13.0±1.2） months, and the Tianji surgical robot group alone was followed up for 10 to 14 months with an average of （12.0±1.3） months. During the follow-up period, the femoral neck fractures of both groups of patients healed well, and no complications such as internal fixation loosening and incision infection occurred. The number of registered fluoroscopy, operation time, and number of intraoperative fluoroscopy of patients in the RTVI group were significantly better than those in the simple Tianji surgical robot group（P<0.01）. There was no statistically significant difference in intraoperative blood loss, hospital stay, Garden alignment index, fracture healing time, and hip Harris score between two groups（P>0.05）. Although RTVI technology assisted by the surgical robot for femoral neck fracture surgery has little impact on its postoperative outcome, it can effectively reduce the operating time, the number of intraoperative X-ray projections, and the risk of intraoperative radiation exposure to patients. It also shortened the learning curve of the operator and better reflected the precision and efficiency of the trauma orthopaedic surgery robot.

Percutaneous endoscopic lumbar discectomy for single and double segment lumbar disc herniation with sciatic scoliosis in adults: a retrospective study

ObjectiveSciatic scoliosis can be seen in patients with lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) is a common surgical method for the treatment of lumbar disc herniation. The difference between single-segment lumbar disc herniation and double-segment lumbar disc herniation with Sciatic Scoliosis in adults after PELD needs further study. The aim of this study was to compare the imaging features of single-segment and double-segment lumbar disc herniation with Sciatic Scoliosis in adults and to further explore the clinical outcomes of functional improvement and scoliosis imaging parameters of the two groups after PELD.MethodsAdult patients with lumbar disc herniation with sciatic scoliosis who received PELD from January 2019 to June 2022 were analyzed retrospectively. According to the number of operative segments, the patients were divided into a single-segment group and a double-segment group. Perioperative parameters were observed and compared between the two groups. The Visual Analogue Scale (VAS) score, Oswestry dysfunction index (ODI), Japanese Orthopaedic Association scores (JOA) and imaging parameters of the two groups were recorded and compared before the operation and during the follow-up.ResultsA total of 53 patients with single segments and 21 patients with double segments were included in this study. During the follow-up, the VAS score, ODI index and JOA score of the two groups were significantly improved as compared with those before the operation(P < 0. 05). Ninety-two point five percent of single-segment patients and 90.5% of double segment patients returned to normal scoliosis within 12 months after the operation. The operation time, number of intraoperative fluoroscopy times and the amount of intraoperative blood loss in single-segment patients were better than those in double-segment group(P < 0. 05). At the last follow-up, the AVT, CBD and SVA in the double-segment group were 5.2 ± 2.3, 5.1 ± 1.0 and 12.2 ± 3.0 mm, respectively, which were higher than those in the single-segment group (1.9 ± 0.4, 1.1 ± 1.6 and 3.9 ± 2.1 mm) (P < 0. 05).ConclusionPELD is an effective treatment for single-segment and double-segment lumbar disc herniation with Sciatic scoliosis. Double-segment patients can enjoy similar clinical efficacy to single-segment patients, avoiding complications caused by decompression, fusion, and internal fixation. Scoliosis was corrected spontaneously within 12 months after operation, and the sagittal curve was significantly improved in both groups. The improvement of coronal and sagittal balance in double -segment patients may take longer.

A new technique of intramedullary elastic reduction of the “de-sharpened” Kirschner wire for the treatment of Gartland type III posterolateral displaced supracondylar fracture of the humerus in children

ObjectiveTo compare the clinical effects of intramedullary elastic reduction of the “de-sharpened Kirschner wire and traditional three-dimensional manipulation in the treatment of Gartland type III posterolateral supracondylar fracture of the humerus in children.MethodsA retrospective cohort analysis was made on 106 cases of Gartland type III posterolateral supracondylar fracture of the humerus treated in the Department of Orthopaedics of a Children’s Hospital from March 2020 to March 2022. According to different surgical technology, the patients were divided into two groups: intramedullary elastic reduction of the de-sharpened Kirschner wire group (experimental group, n = 50) and traditional three-dimensional manipulation group (control group, n = 56). The surgical operating time, intraoperative fluoroscopy times, postoperative Baumann angle changes, postoperative elbow function Flynn score, and complications were collected and compared between the two groups.ResultsAll the enrolled cases underwent surgery successfully and were followed-up at least 6 months. The surgical operating time of the experimental group was 32.88 ± 3.69 min and that of the control group was 45.56 ± 10.13 min, and the difference was statistically significant (P < 0.05). The intraoperative fluoroscopy times were 20.62 ± 5.41 times in the experimental group and 32.48 ± 8.20 times in the control group (P < 0.05). The change of Baumann angle in the experimental group after operation was 2.3 ± 1.3 and that in the control group was 6.0 ± 2.1 (P < 0.5). Elbow joint Flynn scoring standard to evaluate the curative effect: the excellent and good rate was 98.00% (49/50) in the experimental group and 92.86% (52/56) in the control group (P > 0.5). There were no complications such as osteomyelitis, compartment syndrome, iatrogenic vascular and nerve injury, and myositis ossificans in either group.ConclusionsGood functional outcome can be obtained with both intramedullary elastic reduction of the de-sharpened Kirschner wire and traditional three-dimensional manipulation for Gartland type III posterolateral displaced supracondylar fracture of the humerus in children; however, the former does not need repeated manipulation, and the operation time is shorter, the number of intraoperative fluoroscopy is less, and the recovery of the Baumann angle is better.

Improved unilateral puncture PVP based on 3D printing technology for the treatment of osteoporotic vertebral compression fracture

To investigate the clinical effect of unilateral percutaneous vertebroplasty (PVP) combined with 3D printing technology for the treatment of thoracolumbar osteoporotic compression fracture. A total of 77 patients with thoracolumbar osteoporotic compression fractures from October 2020 to April 2022 were included in the study, all of which were vertebral body compression fractures caused by trauma. According to different treatment methods, they were divided into experimental group and control group. Thirty-two patients used 3D printing technology to improve unilateral transpedicle puncture vertebroplasty in the experimental group, there were 5 males and 27 females, aged from 63 to 91 years old with an average of (77.59±8.75) years old. Forty-five patients were treated with traditional bilateral pedicle puncture vertebroplasty, including 7 males and 38 females, aged from 60 to 88 years old with an average of(74.89±7.37) years old. Operation time, intraoperative C-arm X-ray times, anesthetic dosage, bone cement injection amount, bone cement diffusion good and good rate, complications, vertebral height, kyphotic angle (Cobb angle), visual analogue scale(VAS), Oswestry disability index (ODI) and other indicators were recorded before and after surgery, and statistically analyzed. All patients were followed up for 6 to 23 months, with preoperative imaging studies, confirmed for thoracolumbar osteoporosis compression fractures, two groups of patients with postoperative complications, no special two groups of patients' age, gender, body mass index (BMI), time were injured, the injured vertebral distribution had no statistical difference(P>0.05), comparable data. Two groups of patients with bone cement injection, bone cement dispersion rate, preoperative and postoperative vertebral body height, protruding after spine angle(Cobb angle), VAS, ODI had no statistical difference(P>0.05). The operative time, intraoperative fluoroscopy times and anesthetic dosage were statistically different between the two groups(P<0.05). Compared with the traditional bilateral puncture group, the modified unilateral puncture group combined with 3D printing technology had shorter operation time, fewer intraoperative fluoroscopy times and less anesthetic dosage. The height of anterior vertebral edge, kyphosis angle (Cobb angle), VAS score and ODI of the affected vertebrae were statistically different between two groups at each time point after surgery(P<0.05). In the treatment of thoracolumbar osteoporotic compression fractures, 3D printing technology is used to improve unilateral puncture PVP, which is convenient and simple, less trauma, short operation time, fewer fluoroscopy times, satisfactory distribution of bone cement, vertebral height recovery and kyphotic Angle correction, and good functional improvement.

Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study

BackgroundBoth Unilateral Biportal Endoscopic Discectomy (UBED) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) have resulted in favorable clinical outcomes in the management of LDH. The aim of this study is to comprehensively compare the efficacy of UBED and PEID in treating migrated LDH in the lower lumbar spine, with a specific focus on high-grade migrated LDH.Methods96 patients who underwent UBED (31 cases) and PEID (65 cases) procedures were enrolled in the study. All patients received a minimum follow-up period of 6 months. Clinical outcomes of the patients were assessed with incision length, operation time, total hemoglobin loss, hospital stay, intraoperative fluoroscopy times, visual analogue scale (VAS) for lower back and leg pain, Oswestry disability index (ODI), modified MacNab criteria, complications, area of lamina loss and increased intervertebral height.ResultsThe VAS scores for lower back and leg pain and ODI significantly decreased in both groups after the operation. Preoperatively, at 1 day, 1 month, and 6 months after the procedure, the VAS and ODI scores exhibited no significant differences between the two groups. There was no significant difference in terms of modified MacNab criteria, area of lamina loss, and increased intervertebral height. The UBED group had a longer incision length, operation time and postoperative hospital stay, and fewer intraoperative fluoroscopy times than to the PEID group. Complications were noted in both groups throughout the follow-up period, but there was no significant difference in the rate of complications. Moreover, there were no notable differences in clinical outcomes between the two groups in the high-grade migrated LDH.ConclusionsBoth UBED and PEID could achieve favorable clinical outcomes for treating migrated LDH at the lower lumbar spine. Despite the longer operative time and postoperative hospital stay associated with the UBED group, UBED remains safe and innovative for treating migrated LDH at the lower lumbar spine.

The use of Three-Dimensional Printing in Orthopaedics: a Systematic Review and Meta-analysis.

3D-printing is a rapidly developing technology with applications in orthopaedics including pre-operative planning, intraoperative guides, design of patient specific instruments and prosthetics, and education. Existing literature demonstrates that in the surgical treatment of a wide range of orthopaedic pathology, using 3D printing shows favourable outcomes. Despite this evidence 3D printing is not routinely used in orthopaedic practice. We aim to evaluate the advantages of 3D printing in orthopaedic surgery to demonstrate its widespread applications throughout the field. We performed a comprehensive systematic review and meta-analysis. AMED, EMBASE, EMCARE, HMIC, PsycINFO, PubMed, BNI, CINAHL and Medline databases were searched using Healthcare Databases Advanced Search (HDAS) platform. The search was conducted to include papers published before 8th November 2020. Clinical trials, journal articles, Randomised Control Trials and Case Series were included across any area of orthopaedic surgery. The primary outcomes measured were operation time, blood loss, fluoroscopy time, bone fusion time and length of hospital stay. A total of 65 studies met the inclusion criteria and were reviewed, and 15 were suitable for the meta-analysis, producing a data set of 609 patients. The use of 3D printing in any of its recognised applications across orthopaedic surgery showed an overall reduction in operative time (SMD = -1.30; 95%CI: -1.73, -0.87), reduction in intraoperative blood loss (SMD = -1.58; 95%CI: -2.16, -1.00) and reduction in intraoperative fluoroscopy time (SMD = -1.86; 95%CI: -2.60, -1.12). There was no significant difference in length of hospital stay or in bone fusion time post-operatively. The use of 3D printing in orthopaedics leads to an improvement in primary outcome measures showing reduced operative time, intraoperative blood loss and number of times fluoroscopy is used. With its wide-reaching applications and as the technology improves, 3D printing could become a valuable addition to an orthopaedic surgeon's toolbox.

Mid-term efficacy of castor stent and in situ fenestration stent in the treatment of type B aortic dissection involving the left subclavian artery: A retrospective single-center study.

To evaluate the midterm efficacy of the Castor stent (CS) versus in situ fenestration (ISF) for reconstructing the left subclavian artery (LSA) in patients with type B aortic dissection (TBAD). Between July 2017 and July 2022, a total of 247 patients with TBAD were enrolled. One hundred thirty-seven patients were treated using CSs (group A), while the remaining 110 patients received ISFs (group B). Data of the two groups were retrospectively analyzed. The success rates of surgery were 99.3% and 95.5% in groups A and B (p=.053), There were no deaths during hospitalization. During surgery, group B showed a longer surgical duration [68.0 (66.0, 77.0) vs. 62.0 (59.0, 66.0) min, p<.001] and intraoperative fluoroscopy time [18.0 (16.0, 20.0) vs. 16.0 (14.0, 18.0) min, p<.001] than group A. The follow-up duration was similar for both groups (44.0vs. 43.0 months, p=.877), and no patient died. Stent-related complications were significantly lower in group A than in group B (1.5%vs. 8.4%, p=.009). Group A had fewer instances entry flow (0.7%vs. 4.7%, p=.048) and stent stenosis (0.7%vs. 2.8%, p=.206) than group B. All reintervention cases (4.7%) were from group B (p=.011). The rate of false aortic lumen thrombosis was significantly higher in group A than in group B (84.6%vs. 72.9%, p=.024). Both CSs and ISFs are evidently safe, feasible, and effective in achieving positive early outcomes in patients undergoing treatment for TBAD. Notably, at midterm follow-up, CSs appeared to be superior to ISF in terms of reducing stent-related complications and minimizing the need for reintervention.

Kirschner wire reconstruction of medial and lateral column periosteal hinge in the treatment of multidirectionally unstable supracondylar fracture of the humerus in children

Aim and objectiveTo compare the clinical effect of reconstruction of internal and lateral column periosteal hinge-assisted treatment with Kirschner wire and internal fixation with Kirschner wire in the treatment of multidirectional unstable supracondylar fractures of humerus in children.MethodsA retrospective cohort study was conducted to analyze the clinical data of 48 patients (31 male, 17 female; mean age: 6.7 ± 2.4 years old) with multidirectionally unstable supracondylar fractures of the humerus treated in our Hospital from August 2020 to August 2022. Twenty-five cases were treated with Kirschner wire reconstruction of the internal and lateral column periosteal hinge assisted by closed reduction and Kirschner wire internal fixation (study group). Twenty-three cases were treated with closed reduction and Kirschner wire internal fixation (control group). The operation time, intraoperative fluoroscopy times, percentage of patients who underwent open reduction after failure of closed reduction, fracture healing time, Baumann angle (BA), shaft-condylar angle (SCA), range of motion (ROM), and Flynn score of elbow at the last follow-up were compared between two groups. Complications such as infection and irritation of Kirschner wire tail were observed in two groups 2 months after the operation.ResultsAll patients were followed up for 10–22 months ([13.85 ± 2.89] months). The average operation time of the control group was 82.1 min, which was significantly longer than that of the study group 32.3 min (P < 0.05). The number of intraoperative fluoroscopy (29.4 ± 9.2) in the control group was significantly higher than that in the study group (15.2 ± 6.3) (P < 0.05). The incision rate of the control group was 17% while that of the study group was 0 (P < 0.05). According to Flynn score, the excellent and good rate of the elbow joint in the control group was 86.9% (20/23). The excellent and good rate of the elbow joint in the study group was 92.0% (23/25) (P > 0.05). There was no significant difference in fracture healing time, BA, SCA, and ROM between the two groups (P > 0.05). No infection or Kirschner wire tail irritation occurred in the two groups during the 2-month follow-up.ConclusionReconstruction of internal and lateral periosteal hinges with Kirscher wire has similar effects to closed reduction and Kirschner wire fixation in the treatment of multidirectionally unstable supracondylar fractures of the humerus in children, but it can shorten the operation time and reduce intraoperative fluoroscopy times and incision rate.

Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation

ObjectiveAlthough spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for double-segment LDH are controversial. To compare the outcomes of percutaneous endoscopic interlaminar discectomy (PEID) versus conventional open lumbar discectomy (COLD) for the treatment of L4/5 and L5/S1 double-segmental LDH.MethodsFrom January 2016 to September 2021, we included 50 patients with double-segmental LDH who underwent PEID (n = 25) or COLD (n = 25). The clinical outcomes between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. Moreover, the incision length, operation time, intraoperative fluoroscopy time, postoperative bedtime, hospital stays, and complications were also recorded and compared after surgery.ResultsIn both groups, the VAS and ODI scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05) According to the modified MacNab criteria, the excellent or good outcome rate was 92% in the PEID group and 88% in the COLD group. The PEID group had shorter incision length, postoperative bedtime, and hospital stays than the COLD group. However, the operation time was shorter and intraoperative fluoroscopy time was fewer in the COLD group. In addition, there was no significant difference between the two groups in terms of surgical complications during the postoperative follow-up period.ConclusionsBoth PEID and COLD have good efficacy and high safety for management of L4/5 and L5/S1 double-segmental LDH. Compared with the COLD group, the PEID group had more operative time as well as more intraoperative fluoroscopy, but it had a more minimally invasive surgical incision as well as faster postoperative recovery.

Unobstructed orthopaedic surgical robot assisted percutaneous iliosacral screw fixation of sacral brittle fractures.

Pelvic fractures mostly result from high-energy injuries in life; the longitudinal fracture of the sacrum is the most common type of sacrum fracture. This study was designed to evaluate the accuracy, safety, and efficacy of percutaneous sacroiliac joint screw placement in the treatment of longitudinal sacrum fractures with the assistance of unobstructed orthopaedic surgery robots. According to different surgical methods, 32 patients were divided into robot group and free hand group, with 16 patients in each group. The operation time, intra-operative blood loss, intra-operative fluoroscopy times, screw placement angle deviation were collected. There were statistically significant differences in terms of angle deviation of screw placement (1.96 ± 0.75° vs. 2.87 ± 1.03°; p = 0.0145), deviation of the guide needle (1.92 ± 0.93 mm vs. 2.91 ± 1.22 mm; p = 0.0209), intra-operative fluoroscopy time (7.25 ± 1.72 s vs. 20.93 ± 5.64 s; p = 0.0000), insertion time of each sacroiliac joint screw (14.72 ± 2.66 min vs. 29.21 ± 5.18 min; p = 0.0000). There was no statistically significant difference in terms of blood loss (100.21 ± 7.37 mL vs. 102.52 ± 8.15 mL; p = 0.4136). These results suggest that orthopaedic surgery robot for the treatment of longitudinal sacrum fracture is safer and provides less irradiation than the traditional freehand methods.

Evaluation of Safety and Efficacy of Preoperative Coronal MRI-Guided Minimally Invasive Surgery for Cervical Spondylotic Radiculopathy.

BACKGROUND Key-hole surgery is a minimally invasive technique that has shown promise in various surgical procedures. This study aimed to assess the clinical effectiveness of preoperative coronal MRI-assisted key-hole surgery for the treatment of patients with cervical spondylotic radiculopathy (CSR). MATERIAL AND METHODS A total of 30 patients diagnosed with CSR and undergoing key-hole surgery with CMRI assistance were included in the study. Various parameters, including surgical segments, incision length, disease duration, operative time, intraoperative fluoroscopy times, intraoperative blood loss, complications, and length of hospitalization, were recorded. Precise measurements of Cobb angles and intervertebral space height were taken before and after the surgical procedure. Surgical outcomes were evaluated using modified Macnab criteria, visual analogue scale (VAS), Japanese Orthopaedic Association Scores (JOA), and neck disability index (NDI). RESULTS The average duration of disease was 6.47±3.29 months, with an average incision length of 1.94±0.15 cm and operative time of 57.83±4.34 minutes. The average intraoperative blood loss was 33.70±9.28 ml, with an average of 3.50±0.73 intraoperative fluoroscopies. The average duration of hospitalization was 4.10±1.27 days. Preoperative and postoperative measurements showed no statistically significant difference in C2-C7 Cobb angles and intervertebral space height. However, there were significant improvements in postoperative VAS, NDI, and JOA scores compared to preoperative scores. The surgical effectiveness rate was 100%, with a high rate of good and excellent outcomes. CONCLUSIONS The findings of this study suggest that preoperative CMRI-assisted key-hole surgery for single-segment CSR is a safe and effective treatment option with low complication rates. The clinical benefits include high security and good outcomes. Further research and larger studies are warranted to validate these findings.